Non Muscle Invasive

Bladder

Cancer

Lawrence Karsh, MD FACS CPI

Director of Research

Attending Urologist

The Urology Center of Colorado

Lawrence I Karsh MD FACS CPI Director of Research

Bladder Cancer

Most frequent malignant tumor of the urinary

tract

Male > female; ratio 3:1

4th most common cancer in men; 8th in Women

72,570 estimated new cases in USA 2013

15,210 estimated deaths in USA 2013

Ages: 50-70 most common; “any” age can get

Most common type is Transitional Cell

70-80% are non-muscle invasive at

presentation

60% are low grade

40% are high grade

50%-70% will recur at 5 yr

10%-30% will progress to muscle invasive

5%-10% are metastatic

Low grade ca can develop into high grade

Natural History- at diagnosis

Bladder Cancer -Risks Smoking – 4x greater risk

Increases with number smoked

? If decreases after quit smoking (>25yr smoke free)

Aniline dyes/aromatic amines Hairdressers, photo processing, painters, truck drivers,

synthetic textiles

Chemicals with leather goods, rubber

Drugs Phenacetin – non steroid-anti inflammatory pain reliever;

not much used any longer (illegal); is used to cut cocaine

Cyclophosphamide – chemotherapeutic agent – leukemia, lymphoma, severe lupus

History of pelvic radiation Prostate, cervical

Chronic irritation/catheters – Squamous cell

Carcinoma

in-situ

“superficial”

Bad Guy

25% high grade cancers have CIS

30-70% muscle invasive tumors have CIS

50% response to BCG

BCG - FDA approved

Thiotepa FDA approved

Mitomycin - NOT FDA approved

Doxorubicin - NOT FDA approved

Valrubicin-FDA approved for

recurrent CIS

Intravesical therapy

Intravesical Therapy- BCG (Mycobacterium bovis)

Bacillus Calmette Guerin

The Tuberculosis vaccine (invented 1921)

Attenuated (weakened) form of Mycobacterium

bovis bacterium

Produces local inflammatory reaction which is

suppose to rev up the T immune system to

destroy cancer

Most effective intravesical agent

Superior for CIS

Cammile Guerin

From today in science

Albert Calmette

From Britianica.com

From microbiologybytes.com

Approved for CIS and recurrent Ta/T1

60-80% cystitis- no pain no gain

Most effective but most risks

Decrease recurrence by 40%

Decrease progression by 27% if use

maintenance

BCG

What is this clinical trial about

and who will benefit?

How does the therapy work?

Side Effects

Intravesical administration of

rAd-IFN with Syn3 was well

tolerated in the phase I trial

Why should I enroll in this trial?

1. Cutting edge treatment

2. May possibly delay or prevent

cystectomy if effective and

approved by the FDA

3. Advance science

4. Help next generation of patients

with similar problem

Where can I find this information?

• www.bcan.org

• www.suoctc.org

• www.clinicaltrials.gov

• www.nccn.org

• www.tucc.com

INSTILADRINTM (RAD-IFN)